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FQHCLA361 ADULT AND CHILD HEALTH INC (Active)
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Main Details
Name
ADULT AND CHILD HEALTH INC
Subdivision Name
Adult and Child Health - Irvington
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-039643
340B ID
FQHCLA361
Grant Number
LALCS31537
Additional Details
Current Program Status
Active
Registration Date
2/1/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/7/2018
Last Recertification Date
2/26/2025
Contacts
Authorizing Official
Adult and Child Health
Jessica Stembel, Chief Clinical Officer
(317) 494-0739
Primary Contact
Adult and Child Health
Dhvani Derasari, 340B Program Manager
(682) 559-8205
Addresses
Street Address
5839 E. Washington Street
Indianapolis, IN 46219
Billing Address
Adult & Child Health Services
8320 Madison Avenue
Adult and Child Health
Indianapolis, IN 46227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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